ROLE OF THE SETON IN THE MANAGEMENT OF ANORECTAL FISTULAS

PURPOSE: To identify the incidence of major fecal incontinence and rec urrence after staged fistulotomy using a seton. METHODS: A five-year r etrospective chart review of 1 16 patients (70 males and 46 females) r anging in age from 18 to 81 years (mean, 42 years), in whom setons wer e placed as part of a surgical procedure for anorectal fistulas, was c arried out. Follow-up ranged from 2 to 61 months (mean, 23 months). RE SULTS: Setons were employed to identify and promote fibrosis around a complex anorectal fistula as part of a staged fistulotomy in 65 patien ts (56 percent). Other indications for seton placement included 24 wom en with anteriorly situated high transsphincteric fistulas (2 1 percen t) and three patients with massive anorectal sepsis (floating. freesta nding anus) (2.5 percent). In addition, setons were used to preclude p remature skin closure and promote controlled long-term fistula drainag e in 21 patients with severe anorectal Crohn's disease (18 percent) an d in three patients with AIDS (2.5 percent). Major fecal incontinence (requiring the use of a perineal pad) occurred in five patients (5 per cent), and recurrent fistulas were noted in three (3 percent). CONCLUS IONS: Staged fistulotomy using a seton is a safe and effective method of treating high or complicated anorectal fistulas.